Assessment of Burden of Constipation in Amyotrophic Lateral Sclerosis and Possible Relationship to Dysautonomia
Ankita Chabra1, Ghazala Hayat1, Timothy Chrusciel1, Anika Mazumder2
1Saint Louis University School Of Medicine, 2Ascension, St. Francis Hospital
Objective:
To assess the burden of constipation in patients with Amyotrophic lateral sclerosis (ALS) and determine its relationship to dysautonomia.
Background:
ALS is a neurodegenerative disorder affecting motor neurons leading to progressive muscle weakness, cramping, dysphagia, and dysarthria. Most patients succumb to respiratory failure. Though ALS is considered a motor neuron disorder, there is growing evidence that ALS is a multisystem disease. Many patients with ALS (PALS) report at least one non motor symptom such as sleep disturbance, cold limbs, painful limbs, urinary urgency, and constipation. Limited knowledge of the prevalence of intestinal dysfunction in ALS. A study postulated that nearly 46% of ALS patients suffer from constipation. There is a lack of evidence and consensus on how to address the severity of constipation in ALS patients.
Design/Methods:
We instituted three pre-established constipation assessment questionnaires - Patient Assessment of Constipation Quality of Life(PAC-QOL), Patient Assessment of Constipation-Symptoms (PAC-SYM) and Self-reported Autonomic Symptoms in Parkinson's disease(SCOPA-AUT) for assessing the severity of patient‐reported symptoms of constipation in PALS and to determine correlation of ALS and dysautonomia. Questionnaires were administered to 57 PALS and data was compared to normal range for the questionnaires and analyzed for statistical significance.
Results:
PALS reporting dysfunction on SCOPA-AUT scale was significantly higher than disease-free control (p-value<0.001). PALS were also found to have significantly higher rates of constipation symptoms and negative effects on quality of life (reported on PAC-SYM & PAC-QOL). A significant negative correlation was observed between PALS’ ALS-FRS score and dysfunction scores with all three questionnaires (p-value<0.001).
Conclusions:
Severity of ALS was associated with higher dysautonomic symptoms. PALS were found to have higher rates of dysautonomia than the general population. This indicates a need for development of ALS specific measures to assess severity of dysautonomia and evaluation of functional & structural dysfunction of the autonomic system.